[Hiring] Provider Relations Associate Analyst @Integrated Resources

Role Description

The Claims & PR (Provider Relations) Advocate will service inbound claim calls from both members and providers or their office support staff. Occasional outbound calls are required to resolve claim issues.

The types of calls a Claims & PR Advocate services may include but are not limited to:

• Inquiries about claim status details
• Claim reprocessing requests
• Provider contract questions
• Requests to update demographics

Due to the wide variety of call types, several applications are required to service these inquiries, and multiple applications are often needed within the same call. Independent problem solving, multitasking, and technical savvy are essential to be able to carry out the responsibilities of this role. Calls must be serviced in a helpful and professional manner.

The primary responsibility of this role is to answer inbound claim calls from members or providers, as well as contracting and Provider Relations related calls from providers. The work environment is structured, and the majority of the day will be spent answering these calls from a queue. Occasional outbound calls may be necessary for issues requiring follow-up.

Within a call a Claims & PR Advocate may:

• Assist a member or provider with understanding how a claim has processed
• Verify claim status for a member or provider
• Educate a member or provider on billing protocols
• Write or correct authorizations to ensure claims are paid correctly
• Send claims for adjustment/reprocessing
• Request duplicate EOBs for a member or provider
• Send a request for a cancelled check copy, to reissue a check, or request a stop pay/do not reissue on a check
• Provide follow-up on issues by making outbound calls when necessary
• Send resources to members and providers via email
• Submit a complaint on the member or provider's behalf
• Send handoff requests to matrix partners for escalated or complex issues
• Assist providers with contract related inquiries and demographic updates
• Independently problem-solve to ensure accurate information is given, exceptional customer service, and first call resolution is achieved

Qualifications

• Bachelor’s Degree required

Requirements

• Training hours are Monday through Friday, 8:30 AM - 5:00 PM CST
• After all the training is completed, the hours for this position will be 10:30 AM - 7:00 PM CST